CLEVELAND, Ohio — Rising Health Insurance Costs Pressure Hospitals

The rise in the number of uninsured or underinsured individuals is creating significant financial strain for hospitals in the U.S., including MetroHealth. When patients can’t pay for their medical care, hospitals end up covering the costs, a burden referred to as charity care, which affects millions annually in Cleveland hospitals.

In fact, the MetroHealth system reported spending $275 million on charity care in the first nine months of 2025, matching its entire expenditure for 2024. This surge has led MetroHealth to revise its charity payment policies, as announced on Oct. 30.

Officials indicate that this uptick in charity care costs aligns with rising out-of-pocket expenses for patients of MetroHealth. In 2023, about 4.9% of a patient’s income was allocated for out-of-pocket healthcare costs, with this figure jumping to 6.6% through September.

Many residents in Ohio struggle to obtain health insurance because they can’t find affordable options from insurance providers or through the Affordable Care Act (ACA) exchanges, according to Ray Hirschman, an adjunct professor in healthcare finance at Case Western Reserve University’s Weatherhead School of Business.

Since federal mandates requiring Americans to purchase health insurance were largely revoked in 2018, many individuals now lack coverage, primarily those who are self-employed or engaged in gig work. Hirschman emphasizes that smaller employers are generally less likely to provide health insurance benefits due to elevated costs.

Some families do have health insurance, but often face substantial out-of-pocket expenses in terms of deductibles and copays. This situation classifies them as underinsured, which is increasingly common. While high-deductible plans are attractive for their lower premiums, they typically come with deductibles ranging from $5,000 to $10,000, coupled with hefty out-of-pocket expenses.

Hirschman notes that even though these plans may shield individuals from disastrous health outcomes, they expose them to significant financial risks that could lead to severe economic hardship.

According to an analysis by KFF, Americans collectively owe a staggering $220 billion in medical debt, with around 14 million people holding medical debt of $1,000 or more, and about 3 million burdened with debts surpassing $10,000.

In Ohio, approximately 9.1% of residents reported having medical debt during 2019-2021. The number of households struggling with medical debt and the cost of health insurance is anticipated to grow even further, particularly due to changes introduced by the Budget Reconciliation Act of 2025.

The so-called “Big Beautiful Bill” complicates the process for individuals to enroll in or maintain coverage within the health insurance market, or Obamacare. Participants are now required to annually update details like income and immigration status, or risk losing their coverage.

As the government shutdown persists, Democrats are advocating to maintain the expanded subsidies under the Affordable Care Act that are set to expire at the year’s end, fearing that their loss could result in soaring premiums and millions losing insurance.

Cuyahoga County Uninsured Rates

In Cuyahoga County, which is affected by changes to MetroHealth’s charity care policy, approximately 11.3% of adults aged 18 to 64 below 400% of the poverty level were uninsured in 2023, according to federal data.

• Portage County: 9.9%
• Medina County: 10.5%
• Lake County: 10.5%
• Lorain County: 11.0%
• Cuyahoga County: 11.3%
• Summit County: 11.4%
• Ashtabula County: 11.4%
• Geauga County: 17.6%

Ohio Uninsured Rates

In 2023, an estimated 6.1% of Ohio’s total population was uninsured, with the state performing similarly compared to neighboring states.

• Michigan: 4.4%
• Pennsylvania: 5.4%
• Kentucky: 5.6%
• West Virginia: 5.9%
• Ohio: 6.1%
• Indiana: 6.8%

Furthermore, when breaking down residents aged 64 and younger with incomes below 200% of the federal poverty level, Ohio presents a comparable picture:

• Michigan: 8.6%
• Kentucky: 9.5%
• West Virginia: 10.3%
• Pennsylvania: 11.0%
• Ohio: 11.3%
• Indiana: 11.7%

Updated Financial Aid Policy

To address soaring charity care costs, which have risen by 40% in the early months of 2024-2025, MetroHealth has introduced a revamped financial assistance policy. This new policy eliminates 100% of free charity care for certain uninsured and underinsured residents of Cuyahoga County.

Under these guidelines, patients opting not to collaborate with a financial counselor will receive a 65% discount on out-of-pocket expenses. Those who engage in counseling can benefit from even larger subsidies.

Residents earning up to 250% of the federal poverty level will continue receiving free MetroHealth services, provided they consult a financial counselor.

For residents making between 251% and 300% of the federal poverty level, a 75% discount will apply, a change from the previous policy where all costs were covered.

Those earning between 301% and 400% of the federal poverty level will receive a 70% discount, whereas they had formerly benefited from a 75% discount.

These discounts are available to both uninsured and underinsured individuals, with MetroHealth also ready to assist with out-of-pocket costs like deductibles and coinsurance.